The events surrounding an admission to care are traumatic to all parties involved.
RECEIVED 65% (Graded merit upper division)
Introduction.
The events surrounding an admission to care are traumatic to all parties involved. I will look at how some of the actions of the professionals involved can help make the transition less stressful. Some examples of how children react to unplanned moves are given to underpin the importance of careful preplanning.
People who move into residential care should do so as far as possible by positive choice, and living there should be a positive experience. Choice is important in so far as the quality of life in care will depend on the cooperation of those involved. An important implication of this is that there need be real and valid alternatives on offer, from which the client may make their choice. An older child, for example may wish to choose between a community care centre and a fostering placement or an elderly person may wish to consider the pros and cons of residential care as against remaining at home with home help support. To give the power of choice to the client is important because "it changes the fundamental dynamics of the relationship between client and professional, and on a wider scale, between the dependent person and society."(A positive Choice, 1988, p8)
Brearleys statement sends out a very clear message that the manner in which the admission process is handled will impact on the people involved for the rest of their lives. By people I mean the person entering care, their family, close relatives, foster parents, and even care workers involved with the case.
A family experiencing times of crisis will most likely be only focussing on the problems and be unable or unwilling to search for solutions. When a decision is reached to admit one of its members to care their problems may be compounded and magnified. There can be a feeling of failure on the part of a parent/carer, rejection on the part of the person entering care, and an overall sense of loss within the family, the separation experience is likely to be very distressing. There will always be a lasting effect but whether this is a positive or negative is dependent on how the admission process is handled. Put another way well planned admissions can result in the client accepting a move to care with positive long-term results. Conversely abrupt moves or those without proper planning and negotiation can result in untold damage to the client. "It takes more time to correct the harm done by inadequate preplacement work than to do the work in the first place". (Fahlberg, 1996, p. 169)
The first duty of a health board faced with a situation that a child might need to be taken into care is to consider what steps might be taken to avoid that necessity and should explore every possible alternative. (Holden, 1980, p. 29.) The visible face of the local authority or health board in this context is the social worker, whose purpose is "to help a client make a better adjustment, help them meet a problem, fill a need, or receive a service"(Biestek, 1961, p. 3)
When a social worker is assigned to a family there may be an overall feeling of intrusion into their private lives and affairs. The social worker will attempt to allay the families fears by taking things slowly at first, by reassuring the clients that he is not here to judge them, he will treat them as individuals with their own individual needs, and reassure them that matters will be kept confidential and only shared with other professionals on the basis of what they need to know to help them.
From the time he meets the family the ...
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When a social worker is assigned to a family there may be an overall feeling of intrusion into their private lives and affairs. The social worker will attempt to allay the families fears by taking things slowly at first, by reassuring the clients that he is not here to judge them, he will treat them as individuals with their own individual needs, and reassure them that matters will be kept confidential and only shared with other professionals on the basis of what they need to know to help them.
From the time he meets the family the social worker is on a fact-finding exercise, listening attentively, observing interactions, and gathering information, all of which is used to investigate the problem.
Brearley (1980) points out that social workers need to be clear about what the basic needs of children are and must exercise great care in assessing the quality of a childs relationship with each parent. It is important to know what the wishes of the parents are as well as the needs of the children. The child should also be involved at a level appropriate to his understanding and verbal ability.
The admission of a person to care is necessary because "it is recognised that there are a number of undesirable possibilities in their current life situations" (Brearley, et al 1980, p. 9) Or put another way, risks. The social worker must take cognisance of the dangers, hazards, strengths, and potential gains and losses in each situation and although there is always uncertainty it is still possible to "clarify and organize factors within a situation through the defined concepts of hazard, strength and danger" (Brearley, et. al.1980, p. 24) It is a process of balancing and counter balancing to achieve a satisfactory solution to the clients' current predicament.
It is important to have all available information on hand, for example previous placements, if any, family constellation, and relationship with extended family. If the child is exhibiting behavioural problems he will be formally assessed, to enable the social worker decide on a suitable and appropriate placement. All the while he will consult with the parents and the child in order that "they can engage in joint planning with a view to finding and agreeing upon a suitable placement and begin preparations to ensure continuity of care for the child"(Brearley et al. 1980, p. 112)
When a decision is reached to place a child in care, it will have a huge impact on all concerned. However during the investigation, assessment and risk analysis the family may have matured within the problem and owing to them being consulted, involved, and kept informed may see the necessity of placement and understand the reasons behind the decision. This is not to imply that they are happy, but begin to see things more clearly and may now be better equipped than heretofore to offer the child their support.
Children moving into care experience a sense of separation and loss, and their immediate family can experience this also. This feeling of separation and loss can manifest itself in different ways and is influenced by a number of factors. The age of the child, stage of development, the attachment between child and parent, the perceptions of the reasons for the separation that the child has, the preparation for the move, the temperament of the child, and the environment from which the child is being moved. "The trauma of parental separation or losses may be lessened if the child is prepared for the transition, and if all participants in the moving process are open and honest with the child" (Fahlberg, 1996, p. 167)
In my workplace we generally admit young boys who come to us through the unplanned process. These young people usually exhibit a wide range of behaviours following admission, for example, bedwetting, violence, verbal abuse to staff and peers, and various degrees of challenging behaviour. It can take a number of weeks and indeed often longer before a boy settles into the environment. I can recall the case of Peter (not his real name) who assaulted a staff member in his previous placement. Following breakfast one morning he was transferred to our centre and he was only informed of the move on the way to the car. His parents were not informed at all. Upon arrival he was absolutely terrified and confused. He proved very difficult to handle and was unable to form a relationship with staff. His parents were also generally hostile towards the staff and it took many months before any form of trust was established between the parties. These are some of the negative aspects of the events that can happen during a rushed or emergency transfer to care, where the opportunity to preplan the admission is missing and the "lasting effect" is damaging to the individual.
Children invariably hope against hope that the need for separation will be averted (Littner, in Brearley et al. 1980, p. 117) When the placement capable of meeting the childs needs is selected the social care worker,(care worker) will play a proactive role. Through training, experience, and from social worker reports they will be aware of the needs of the child. They will have from experience some insight into what the child may be feeling particularly if he is being admitted to care for the first time. The noise and activity will be different from home. He will be confronted with other children, care staff, and other workers, all strangers. What must he be thinking? What will this place be like? How long am I to stay? What will the people be like? How will I fit in? What am I supposed to do when I get there? The trauma that he is currently experiencing may be considerably lessened if the child is prepared in advance.
The care worker will meet the child in advance of the admission date because the child will have visited the centre more than once accompanied by parents and social worker. These visits will have taken place at different times, initially when the unit is quiet and the other children are at school or away for the day. This affords the care worker time to get to know the child, explore likes and dislikes, favourite foods, TV. programmes, sports, toys and so on. Visits will then move to a point where the child meets the other children, and leads up to a point where a number of sleepovers take place. At this stage the child will possess a good deal of knowledge about the centre, the care workers and his peers. His peers will also be prepared for the arrival of a new child into the group. "Preplacement contacts are used to transform the unknown into the known". (Fahlberg, 1996, p. 170)
On the day of admission the care worker is sensitive to the feelings of the child. Personal belongings are carefully put away in the child's locker, photographs, posters, and other personal items are given pride of place in the child's room. By doing this it maintains links to the past that may be a source of comfort to the child. The care worker will assist the child integrate with the other children and be aware that it will take time for the child to adjust in its new setting.
The trauma of separation and its lasting effects can be minimised for all the parties involved and "what the worker does at such a time is therefore of very great significance"(Brearley et al. 1980, p. 205)
I have already mentioned that admissions to my workplace are unplanned. . When he is delivered to the centre he will be admitted in a very relaxed atmosphere in order to introduce the boy to his new environment, always being aware that the boy is most likely feeling very apprehensive and probably very frightened. We do not push for detailed information at this time, as his file will reach the centre in a day or two. Contact with a parent is immediately encouraged, we tease out what sports he likes, ask about his favourite food, music, football team and so on. Staff will remain with him for a considerable period of time in order to make his experience less traumatic and as positive as possible.
Because of the dynamics of the client group a new admission is integrated slowly to the group usually mixing with a small number of boys to start. During his stay with us we maintain a daily record of our observations, devise a care plan to meet his individual needs, citing short and long-term goals, prepare case conference reports, and ultimately preplan for the boy to return home.
Isolation from loved ones results in adjustment problems while in care and afterwards so it is necessary that the social care worker be aware of these factors and take steps to relieve the clients anxiety and there is no better place to start building a relationship than at the admission process.
Conclusion
In as far as possible people who move into care should do so by positive choice. The implications for the client, already in crisis due to their difficulties, of rushed or poor planning can be lifelong. The social worker by using his professional skills will attempt to ease the way so as to ensure the experience is less damaging to the individual. However in a centre where all admissions are unplanned the care worker takes a pivotal role in helping the client settle in and working with him during his stay to preplanning his discharge.
Bibliography
Biestek, F.P. 1961, The Casework Relationship, George Allen & Unwin,
London.
Brearley, P. Hall, F. Gutridge,P. Jones, G. Roberts,g. 1980 Admission to Residential Care, Tavistock Publications Ltd, London
Craig, S. Donnellan, M. Graham, G. Warren, A. 1998, Learn to Listen. The Irish Report of a European Study on Residential Care. DIT Dublin.
Fahlberg, V.I. 1996, A Childs Journey Through Placement, British Agencies for Adoption & Fostering, London.
Holden, A.S. 1980, Children in Care, Coymn Books, Lemmington Spa.
Residential Care A Positive Choice, 1988, Her Majesty's Stationery Office, London.
